Skip to main content

Advertisement

SpringerLink
Log in

Left-Sided Breast Irradiation does not Result in Increased Long-Term Cardiac-Related Mortality Among Women Treated with Breast-Conserving Surgery

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Standard therapy following lumpectomy for breast cancer has included adjuvant whole-breast radiotherapy. Recent, long-term studies have suggested a possible association between left-sided whole breast radiotherapy and long-term cardiac-related mortality. We sought to determine whether left-sided breast cancers treated with breast-conserving treatment have worse cardiac-related outcomes.

Methods

The surveillance, epidemiology, and end results database was queried for female breast cancer cases diagnosed from 1990 to 1999. Subjects who underwent lumpectomy and adjuvant radiotherapy were included for study and grouped according to laterality. The primary outcome measure was the rate of cardiac-related mortality. Secondary outcome measures were overall and cancer-specific survival. A Cox proportional hazards model was constructed to analyze the primary outcome measure and included age, race, grade, stage, hormone receptor status, and histologic subtype.

Results

A total of 66,687 subjects were identified. These were divided equally by laterality groups: 33,866 left (50.8 %) and 32,801 right (49.2 %). Median follow-up was 15.5 years, and the groups were otherwise well-matched. Left-sided cancer was not associated with poorer survival for any of the metrics. Fifteen-year overall survival and disease-specific survival were 62.8 and 87.0 % for left-sided and 63.0 and 87.1 % for right-sided breast cancers, respectively (p = 0.260, p = 0.702). Rate of cardiac-related mortality at 5-, 10-, and 15-year follow-up were 1.5, 4.3, and 7.7 % for left-sided cancers and 1.6, 4.4, and 8.0 % for right-sided cancers, respectively (p = 0.435).

Conclusions

In this large population-based study, women receiving left-sided external beam radiation for breast cancer did not have an increase in cardiac-related mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366:2087–106.

    Article  CAS  PubMed  Google Scholar 

  2. Early Breast Cancer Trialists’ Collaborative Group. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2005;378:1707–16.

    Google Scholar 

  3. Cuzick J, Stewart H, Rutqvist L, Houghton J, Edwards R, Redmond C, et al. Cause-specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy. J Clin Oncol. 1994;12:447–53.

    CAS  PubMed  Google Scholar 

  4. Bouillon K, Haddy N, Delaloge S, Garbay JR, Garsi JP, Brindel P, et al. Long-term cardiovascular mortality after radiotherapy for breast cancer. J Am Coll Cardiol. 2011;57:445–52.

    Article  PubMed  Google Scholar 

  5. Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Brønnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368:987–98.

    Article  CAS  PubMed  Google Scholar 

  6. Henson KE, McGale P, Taylor C, Darby, SC. Radiation-related mortality from heart disease and lung cancer more than 20 years after radiotherapy for breast cancer. Br J Cancer. 2013;108:179–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Jagsi R, Moran J, Marsh R, Masi K, Griffith KA, Pierce LJ. Evaluation of four techniques using intensity-modulated radiation therapy for comprehensive locoregional irradiation of breast cancer. Int J Radiat Oncol Biol Phys. 2010;78:1594–603.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lohr F, El-Haddad M, Dobler B, Grau R, Wertz HJ, Kraus-Tiefenbacher U, et al. Potential effect of robust and simple IMRT approach for left-sided breast cancer on cardiac mortality. Int J Radiat Oncol Biol Phys. 2009;74:73–80.

    Article  PubMed  Google Scholar 

  9. Schubert LK, Gondi V, Sengbusch E, Westerly DC, Soisson ET, Paliwal BR, et al. Dosimetric comparison of left-sided whole breast irradiation with 3DCRT, forward-planned IMRT, inverse-planned IMRT, helical tomotherapy, and topotherapy. Radiother Oncol. 2011;100:241–6.

    Article  PubMed  Google Scholar 

  10. National Cancer Institute. Overview of the SEER program. http://seer.cancer.gov/about/overview.html. Accessed 15 March 2015.

  11. Hu CY, Xing Y, Cormier JN, Chang GJ. Assessing the utility of cancer-registry-processed cause of death in calculating cancer-specific survival. Cancer. 2013;119:1900–07.

    Article  PubMed  PubMed Central  Google Scholar 

  12. National Cancer Institute. SEER cause-specific death classification. http://seer.cancer.gov/causespecific. Accessed 16 Sept 2015.

  13. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.

    Article  PubMed  Google Scholar 

  14. Doyle JJ, Neugut AI, Jacobson JS, Wang J, McBride R, Grann A, et al. Radiation therapy, cardiac risk factors, and cardiac toxicity in early-stage breast cancer patients. Int J Radiat Oncol Biol Phys. 2007;68:82–93.

    Article  PubMed  Google Scholar 

  15. Correa CR, Litt HI, Hwang WT, Ferrari VA, Solin LJ, Harris EE. Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer. J Clin Oncol. 2007;25:3031–7.

    Article  PubMed  Google Scholar 

  16. Poortmans PM, Colette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med. 2015;373:317–27.

    Article  CAS  PubMed  Google Scholar 

  17. Lievens Y, Poortmans P, Van den Bogaert W. A glance on quality assurance in EORTC study 22922 evaluating techniques for internal mammary and medial supraclavicular lymph node chain irradiation in breast cancer. Radiother Oncol. 2001;60:257–65.

    Article  CAS  PubMed  Google Scholar 

  18. Giordano SH, Kuo YF, Freeman JL, Buchholz TA, Hortobagyi GN, Goodwin JS. Risk of cardiac death after adjuvant radiotherapy for breast cancer. J Natl Cancer Inst. 2005;97:419–24.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Patt DA, Goodwin JS, Kuo YF, Freeman JL, Zhang DD, Buchholz TA, et al. Cardiac morbidity of adjuvant radiotherapy for breast cancer. J Clin Oncol. 2005;23:7475–82.

    Article  PubMed  Google Scholar 

  20. Giordano SH, Kuo YF, Freeman JL, Buchholz TA, Hortobagyi GN, Goodwin JS. Risk of cardiac death after adjuvant radiotherapy for breast cancer. J Natl Cancer Inst. 2005;97:419–24.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Darby SC, McGale P, Taylor CW, Peto R. Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: prospective cohort study of about 300,000 women in US SEER cancer registries. Lancet Oncol. 2005;6:557–65.

    Article  PubMed  Google Scholar 

  22. Onwudiwe NC, Kwok Y, Onukwugha E, Sorkin JD, Zuckerman IH, Shaya FT, et al. Cardiovascular event-free survival after adjuvant radiation therapy in breast cancer patients stratified by cardiovascular risk. Cancer Med. 2014;3:1342–52.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hughes KS, Schnaper LA, Berry JR, Cirrincione C, McCormick B, Shank B, et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med. 2004;351:971–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

The authors have no conflicts of interests or sources of funding to report.

Author information

Author notes

  1. G. Paul Wright MD

    Present address: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

Authors and Affiliations

  1. Grand Rapids Medical Education Partners/Michigan State University General Surgery Residency Program, Grand Rapids, MI, USA

    G. Paul Wright MD, James J. Drinane DO & Mathew H. Chung MD, FACS

  2. Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA

    G. Paul Wright MD, Holly L. Sobel BS & Mathew H. Chung MD, FACS

  3. Division of Surgical Specialties, Spectrum Health Medical Group, Grand Rapids, MI, USA

    G. Paul Wright MD & Mathew H. Chung MD, FACS

Authors
  1. G. Paul Wright MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James J. Drinane DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Holly L. Sobel BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mathew H. Chung MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Paul Wright MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Paul Wright, G., Drinane, J.J., Sobel, H.L. et al. Left-Sided Breast Irradiation does not Result in Increased Long-Term Cardiac-Related Mortality Among Women Treated with Breast-Conserving Surgery. Ann Surg Oncol 23, 1117–1122 (2016). https://doi.org/10.1245/s10434-015-4949-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-4949-6

Keywords

Search

Navigation